Many women get a double mastectomy when only one breast has tumors

Women with cancer in one breast may choose to have both breasts removed, even though a double mastectomy is not always linked to improved survival odds, a recent study suggests.

Researchers analyzed survey data from women with early stage cancer in one breast, and 17 percent had both breasts surgically removed as part of the treatment.

“For most women with breast cancer, who do not have a hereditary genetic mutation that predisposes them to a high risk of cancer formation, the risk of developing a second breast cancer in the other breast is actually quite low,” said lead study author Dr. Reshma Jagsi of the University of Michigan in Ann Arbor.

“The removal of the other breast is a very aggressive approach with little benefit for most women with breast cancer,” Jagsi added by e-mail. “Nevertheless, most women tell us that they pursue this option for peace of mind, for me, this suggests that at least some women are not fully informed.”

Most women with breast cancer have some type of surgery – a lumpectomy removes malignant tissue while sparing the rest of the breast or a mastectomy which removes the entire breast. After the surgery, many of them also receive chemotherapy to destroy any remaining abnormal cells, and reduces the risk of cancer coming back.

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A double mastectomy for cancer in one breast was rare ten years ago, but has become more commonplace in recent years, Jagsi said.

Most women without a genetic risk for aggressive disease are not likely to develop tumors in second breast after the cancer is discovered in one breast. In fact, they are more likely to develop cancer in other parts of their body, instead of in the second breast, she noted.

For the study, researchers collected data in 2013 and 2014 of approximately 2400 women with tumours in one breast.

Overall, 1,056 women, or 44 percent, considered a double mastectomy. Of these, 395 women, or less than half, knew that this course of treatment will not improve survival chances for all women with breast cancer, researchers report in JAMA Surgery.

Two-thirds of the participants in the study do not have a high genetic risk for aggressive tumors, and 39 percent of these women says a surgeon had advised against a double mastectomy.

In the subgroup of women without a hereditary risks, or the identified mutation that increases the odds for aggressive tumors, 12 percent still had both breasts surgically removed

Under this low-risk women, 19 percent of the patients who were not advised against a double mastectomy by doctors, underwent the procedure.

This more aggressive surgical approach to breast cancer carries an increased risk of pain and complications, especially if the women also choose to have reconstructive plastic surgery.

A limitation of the study is the dependence of women to accurately remember and report what they discussed with the physicians in choosing a course of treatment, the authors note.

Still, the results highlight a need to balance a psychological advantage women can get the peace of mind that comes with the removal of both breasts to the long-term damage from an unnecessary surgery, Dr. Shelley Hwang writes in an accompanying editorial.

In the United States, about one in 10 women with cancer in one breast decide to have the other breast removed as a preventive measure, Hwang, a researcher at Duke University Medical Center in Durham, North Carolina, said by e-mail.

“This is a number that is greatly increased in the past 20 years,” said Hwang.

“This trend is concerned, many of us have, which ensure that women taking this decision is based on an incorrect understanding of how much they can benefit from having this procedure,” Hwang added. “The current study is important because it surveyed patients about how they make the decision to have the other breast removed, and that a better training of the patients by their surgeons can help reverse this trend.”

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